Managing Dual Practice of Health Workers: Evidence from Indonesia

50 Pages Posted: 6 Aug 2020 Last revised: 16 Nov 2022

See all articles by Paula Gonzalez

Paula Gonzalez

Universidad Pablo de Olavide

Gabriel Montes‐Rojas

University of Buenos Aires (UBA)

Sarmistha Pal

University of Surrey; IZA Institute of Labor Economics

Date Written: November 8, 2022

Abstract

This paper analyses the causal effects of private practice of public health workers on public health provision in Indonesia. We exploit the exogenous variation in the initiation of private practice after the 1997 Ministry of Health regulation 916 that required health professionals to apply for a license for private practice after at least three years of compulsory service after graduation. Instrumental variables (IV) estimates, built around the cut-off experience of 3 years after 1997, suggest that dual practitioners (relative to those engaged in public puskesmas only) work significantly less hours per week, but see significantly more patients in public facilities. Results hold even after we drop the defiers. We rule out the influence of unobserved confounding factors like workers’ ability and attribute these results to dual practice rather than higher efficiency of dual practitioners. Finally, observed effects are worse when the private practice is held away from the puskesmas.

Note:
Funding Information: MISSING

Conflict of Interests: MISSING

Keywords: Dual Practice of Health Professionals, Indonesia, Ministry of Health Regulation 916, Weak Monitoring, Difference-in-Difference Regression Discontinuity Design

JEL Classification: I10, I18, J2, J44, J45, O1

Suggested Citation

Gonzalez, Paula and Montes‐Rojas, Gabriel and Pal, Sarmistha, Managing Dual Practice of Health Workers: Evidence from Indonesia (November 8, 2022). Available at SSRN: https://ssrn.com/abstract=3647101 or http://dx.doi.org/10.2139/ssrn.3647101

Paula Gonzalez

Universidad Pablo de Olavide ( email )

Ctra. Utrera, Km.1
Sevilla, Seville 41010
Spain
+34 954 34 83 80 (Phone)
+34 954 34 93 39 (Fax)

Gabriel Montes‐Rojas

University of Buenos Aires (UBA) ( email )

Av. Cordoba 2122
Buenos Aires, Buenos Aires 1120
Argentina

Sarmistha Pal (Contact Author)

University of Surrey ( email )

Stag Hill
Guildford, England GU2 7XH
United Kingdom
01483 683995 (Phone)

IZA Institute of Labor Economics

P.O. Box 7240
Bonn, D-53072
Germany

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